National Medicare Health Segmentation Study
Available: January 5, 2026
Available: January 5, 2026
Higher utilization and MLR pressures demand that Medicare stakeholders better understand the health needs of their beneficiaries than ever before. This first-of-its-kind syndicated study illuminates the health segments within our clients’ senior population so that organizations can best serve their unique needs.
In fact, this National Medicare Health Segmentation Study is so critical that all relevant 2026 Deft SMIS studies will reference this segmentation study to help ensure that operations, sales, product, marketing, and experience-focused managers can apply its insights into their daily work. As part of the service, Deft will score the first 25,000 members — at no additional cost — so that all plan managers can have a clear understanding how to best service each individual member.
Healthy Hesitants are characterized by very low rates of utilization and a greater degree of skepticism toward providers and insurers — which translates to lower CAHPS overall health plan ratings than the other segments.
Focused and Fortunates typically have a higher income compared to other segments and are also more likely to have a MedSupp insurance policy.
Steady Maintainers typically manage several common conditions or ailments for seniors (around five). They are also more likely to be Dual Eligible than other segments.
Episodically Engaged manage a higher number of conditions (about five on average) and use a moderate amount of primary care. But unlike Steady Maintainers, they use more emergency care in response to specific episodes.
Metabolic Care Users manage many different conditions (over seven, on average). They strongly over-indexing on metabolic issues, as well as comorbidities such as heart disease, stroke, and vision issues.
Complex Care Users is the segment holding the weakest belief that they are in control of their own health outcomes, yet they place the most trust in health insurers to cover their care without issues.